<!-- AS法人お問合せ入力画面 -->
{$subblock.script_as}
	<div id="contents">
		<h2>お問い合わせ</h2>
		<img src="/app/images/inquiry/main.jpg" alt="社宅に関するお問い合わせは以下フォームからお願い致します。弊社よりご連絡させていただきます。" width="720" height="86">
		<div id="main">
		<p>「<a href="http://www.apamanshop-hd.co.jp/info/privacy.html" target="_blank">個人情報の取り扱いについて</a>」をご確認・同意の上、お問い合わせ下さい。</p>
				<table id="corporateForm" cellpadding="0" cellspacing="0" class="reg mt10">
					<tr>
						<th>貴社名<span class="strong">[必須]</span></th>
						<td>
							<input id="Company" name="Company" value="{$Company}" class="required" type="text" size="30" maxlength="20" style="IME-MODE: active">
							<p class="errTxt" htmlfor="Company" generated="true"></p>
						</td>
					</tr>
					<tr>
						<th>住所<span class="strong">[必須]</span></th>
						<td>
							〒
							<input type="text" name="Zip1" value="{$Zip1}" id="Zip1" maxlength="3" class="required number"  style="IME-MODE: disabled" />
							－
							<input type="text" name="Zip2" value="{$Zip2}" id="Zip2" maxlength="4" class="required number"  style="IME-MODE: disabled" />
							<br>
							都道府県
							<select name="PrefCd" id="PrefCd" class="required">
								<option value="00" {if $PrefCd == "00" } selected {/if}>選択して下さい</option>
								<option value="01" {if $PrefCd == "01" } selected {/if}>北海道</option>
								<option value="02" {if $PrefCd == "02" } selected {/if}>青森県</option>
								<option value="03" {if $PrefCd == "03" } selected {/if}>岩手県</option>
								<option value="04" {if $PrefCd == "04" } selected {/if}>宮城県</option>
								<option value="05" {if $PrefCd == "05" } selected {/if}>秋田県</option>

								<option value="06" {if $PrefCd == "06" } selected {/if}>山形県</option>
								<option value="07" {if $PrefCd == "07" } selected {/if}>福島県</option>
								<option value="08" {if $PrefCd == "08" } selected {/if}>茨城県</option>
								<option value="09" {if $PrefCd == "09" } selected {/if}>栃木県</option>
								<option value="10" {if $PrefCd == "10" } selected {/if}>群馬県</option>
								<option value="11" {if $PrefCd == "11" } selected {/if}>埼玉県</option>

								<option value="12" {if $PrefCd == "12" } selected {/if}>千葉県</option>
								<option value="13" {if $PrefCd == "13" } selected {/if}>東京都</option>
								<option value="14" {if $PrefCd == "14" } selected {/if}>神奈川県</option>
								<option value="15" {if $PrefCd == "15" } selected {/if}>新潟県</option>
								<option value="16" {if $PrefCd == "16" } selected {/if}>富山県</option>
								<option value="17" {if $PrefCd == "17" } selected {/if}>石川県</option>

								<option value="18" {if $PrefCd == "18" } selected {/if}>福井県</option>
								<option value="19" {if $PrefCd == "19" } selected {/if}>山梨県</option>
								<option value="20" {if $PrefCd == "20" } selected {/if}>長野県</option>
								<option value="21" {if $PrefCd == "21" } selected {/if}>岐阜県</option>
								<option value="22" {if $PrefCd == "22" } selected {/if}>静岡県</option>
								<option value="23" {if $PrefCd == "23" } selected {/if}>愛知県</option>

								<option value="24" {if $PrefCd == "24" } selected {/if}>三重県</option>
								<option value="25" {if $PrefCd == "25" } selected {/if}>滋賀県</option>
								<option value="26" {if $PrefCd == "26" } selected {/if}>京都府</option>
								<option value="27" {if $PrefCd == "27" } selected {/if}>大阪府</option>
								<option value="28" {if $PrefCd == "28" } selected {/if}>兵庫県</option>
								<option value="29" {if $PrefCd == "29" } selected {/if}>奈良県</option>

								<option value="30" {if $PrefCd == "30" } selected {/if}>和歌山県</option>
								<option value="31" {if $PrefCd == "31" } selected {/if}>鳥取県</option>
								<option value="32" {if $PrefCd == "32" } selected {/if}>島根県</option>
								<option value="33" {if $PrefCd == "33" } selected {/if}>岡山県</option>
								<option value="34" {if $PrefCd == "34" } selected {/if}>広島県</option>
								<option value="35" {if $PrefCd == "35" } selected {/if}>山口県</option>
								<option value="36" {if $PrefCd == "36" } selected {/if}>徳島県</option>
								<option value="37" {if $PrefCd == "37" } selected {/if}>香川県</option>
								<option value="38" {if $PrefCd == "38" } selected {/if}>愛媛県</option>
								<option value="39" {if $PrefCd == "39" } selected {/if}>高知県</option>
								<option value="40" {if $PrefCd == "40" } selected {/if}>福岡県</option>
								<option value="41" {if $PrefCd == "41" } selected {/if}>佐賀県</option>

								<option value="42" {if $PrefCd == "42" } selected {/if}>長崎県</option>
								<option value="43" {if $PrefCd == "43" } selected {/if}>熊本県</option>
								<option value="44" {if $PrefCd == "44" } selected {/if}>大分県</option>
								<option value="45" {if $PrefCd == "45" } selected {/if}>宮崎県</option>
								<option value="46" {if $PrefCd == "46" } selected {/if}>鹿児島県</option>
								<option value="47" {if $PrefCd == "47" } selected {/if}>沖縄県</option>
							</select>
							<br>
							市区町村
							<INPUT type="text" name="Address1" id="Address1" value="{$Address1}" class="required" size="40" maxlength="70" style="ime-mode:active">
							<br>
							町名以下
							<INPUT type="text" name="Address2" id="Address2" value="{$Address2}" class="required" size="40" maxlength="70" style="ime-mode:active">
							<p class="errTxt" htmlfor="address" generated="true" />
						</td>
					</tr>
					<tr>
						<th>部署名<span class="strong">[必須]</span></th>
						<td>
							<INPUT type="text" name="Busho" id="Busho"  value="{$Busho}" class="required" maxlength="30" size="30" style="ime-mode:active">
							<p class="errTxt" htmlfor="Busho" generated="true" />
						</td>
					</tr>
					<tr>
						<th valign="top">役職名</th>
						<td valign="top">
							<INPUT type="text" name="Yakushoku" id="Yakushoku" value="{$Yakushoku}" maxlength="30" size="30" style="ime-mode:active">
						</td>
					</tr>
					<tr>
						<th>担当者名<span class="strong">[必須]</span></th>
						<td>お名前
							<INPUT type="text" name="ChargeNm" id="ChargeNm" value="{$ChargeNm}" class="required zenkaku" maxlength="30" size="24" style="ime-mode:active">
							例：山田　太郎<br>							フリガナ
							<INPUT type="text" name="ChargeNmKana" id="ChargeNmKana" value="{$ChargeNmKana}" class="required furikana" maxlength="30" size="24" style="ime-mode:active">
							例：ヤマダ　タロウ
							<p class="errTxt" htmlfor="ChargeNm" generated="true" />
							<p class="errTxt" htmlfor="ChargeNmKana" generated="true" />
						</td>
					</tr>
					<tr>
						<th>電話番号<span class="strong">[必須]</span> </th>
						<td>
							<INPUT type="text" name="Tel" id="Tel" value="{$Tel}" class="required numhifun" size="24" maxlength="13" style="ime-mode:inactive">
							例：01-2345-6789
							<p class="errTxt" htmlfor="Tel" generated="true" />
						</td>
					</tr>
					<tr>
						<th valign="top">FAX</th>
						<td valign="top">
							<INPUT type="text" name="Fax" id="Fax" value="{$Fax}" class="numhifun" size="24" maxlength="13" style="ime-mode:inactive">
							例：01-2345-6789
							<p class="errTxt" htmlfor="Fax" generated="true" />
						</td>
					</tr>
					<tr>
						<th>メールアドレス</th>
						<td>
							<INPUT type="text" name="Mail" id="Mail" value="{$Mail}" class="email" size="30" maxlength="50" style="IME-MODE: disabled">
						</td>
					</tr>
					<tr>
				     	<th>URL</th>
				     	<td>
				     		<INPUT name="Url" type="text" value="{$Url}" id="Url" size="30" maxlength="50" style="IME-MODE: disabled">
				     	</td>
					</tr>
					<tr>
						<th>お問い合わせ内容<span class="strong">[必須]</span></th>
						<td>
							<input type="checkbox" name="Inquiry1" value="社宅事務代行について" id="Inquiry1" class="required" {if $Inquiry1 == "社宅事務代行について"} checked {/if} />
							社宅事務代行について<br>
							<input type="checkbox" name="Inquiry2" value="お部屋探し依頼について" id="Inquiry2" class="required" {if $Inquiry2 == "お部屋探し依頼について"} checked {/if} />
							お部屋探し依頼について<br>
							<input type="checkbox" name="Inquiry3" value="その他全般" id="Inquiry3" class="required" {if $Inquiry3 == "その他全般"} checked {/if} />
							その他全般
							<p class="errTxt" htmlfor="inq" generated="true" />
						</td>
					</tr>
					<tr>
				     	<th>備考</th>
				     	<td>ご要望などございましたらご記入下さい 。(500文字以内) <br>
				       		<textarea name="Comment" id="Comment" class="maxlength" maxlength="500" cols="40" rows="13" style="ime-mode:active">{$Comment}</textarea>
		   					<p class="errTxt" htmlfor="Comment" generated="true" />
						</td>
					</tr>
				</table>
				<div class="waku01">
				<div class="ssl_l">
					<!-- end main -->
					<div class="main_text">SSL暗号化通信を使用していますので、安心して個人情報を送信いただけます。</div>
{*					<!-- end main -->
					<div class="main_mark"></div>
					<!-- end left -->
					<div class="c-both"></div>*}
				</div>
				<div class="ssl_r">
					<a href="javascript:void(0);">
					<img class="btn" src="/app/images/inquiry/btn_check.gif" alt="個人情報の取り扱いについて」に同意の上　入力内容を確認" onclick="javascript:corporateEntrySubmit(); return false;" />
					</a>
				</div>
				<!-- end main -->
				<!-- end right -->
				<div class="c-both"></div>
				</div>
				<div class="privacy">
			<table>
					<tr>
						<td class="text_blue">▼必ずお読み下さい。</td>
						<td id="toi_right">※下記の内容は、<a href="http://www.apamanshop-hd.co.jp/info/privacy.html" target="_blank">こちら</a>でもご確認いただけます。 </td>
					</tr>
					<tr>
						<td colspan="2" class="kojin">個人情報の取り扱いについて</td>
					</tr>
					<tr>
						<td colspan="2" class="iFrame">
							<iFrame src="http://www.fcapamanshop.com/privacy.html" width="100%" height="150" scrolling="auto" frameborder="0"></iFrame>
						</td>
					</tr>
				</table>
				</div>
		</div>
		<div class="jumptoTop">
			<a href="javascript:void(0);" onclick="jumpToPageTop();return false;" onkeypress="jumpToPageTop();return false;">ページの先頭へ戻る
			</a>
		</div>

<!-- 共通パラメータここから -->
<input type="hidden" id="CntctWayFax" name="CntctWayFax" value="{$CntctWayFax}" />
<input type="hidden" id="CntctWayMail" name="CntctWayMail" value="{$CntctWayMail}" />
<input type="hidden" id="CntctWayTel" name="CntctWayTel" value="{$CntctWayTel}" />
<input type="hidden" id="CntctWayCd" name="CntctWayCd" value="{$CntctWayCd}" />
<input type="hidden" id="CntctWayStr" name="CntctWayStr" value="{$CntctWayStr}" />
<!-- <input type="hidden" id="Fax" name="Fax" value="{$Fax}" /> -->
<!-- <input type="hidden" id="Inquiry1" name="Inquiry1" value="{$Inquiry1}" /> -->
<!-- <input type="hidden" id="Inquiry2" name="Inquiry2" value="{$Inquiry2}" /> -->
<!-- <input type="hidden" id="Inquiry3" name="Inquiry3" value="{$Inquiry3}" /> -->
<input type="hidden" id="Inquiry4" name="Inquiry4" value="{$Inquiry4}" />
<input type="hidden" id="Inquiry5" name="Inquiry5" value="{$Inquiry5}" />
<!-- <input type="hidden" id="Mail" name="Mail" value="{$Mail}" /> -->
<input type="hidden" id="MailMgznFlg" name="MailMgznFlg" value="{$MailMgznFlg}" />
<input type="hidden" id="Name" name="Name" value="{$Name}" />
<input type="hidden" id="NameMei" name="NameMei" value="{$NameMei}" />
<input type="hidden" id="NameSei" name="NameSei" value="{$NameSei}" />
<input type="hidden" id="KanaSei" name="KanaSei" value="{$KanaSei}" />
<input type="hidden" id="KanaMei" name="KanaMei" value="{$KanaMei}" />
<input type="hidden" id="NeedTimeKbn" name="NeedTimeKbn" value="{$NeedTimeKbn}" />
<input type="hidden" id="PlaceKbn" name="PlaceKbn" value="{$PlaceKbn}" />
<input type="hidden" id="ShopCd" name="ShopCd" value="{$ShopCd}" />
<!-- <input type="hidden" id="Tel" name="Tel" value="{$Tel}" /> -->
<input type="hidden" id="UseKbn" name="UseKbn" value="{$UseKbn}" />
<input type="hidden" id="SrhKbn" name="SrhKbn" value="{$SrhKbn}" />
<input type="hidden" id="OemCd" name="OemCd" value="{$OemCd}" />
<!-- <input type="hidden" id="Url" name="Url" value="{$Url}" /> -->
<!-- <input type="hidden" id="Company" name="Company" value="{$Company}" /> -->
<input type="hidden" id="CtgryCd" name="CtgryCd" value="{$CtgryCd}" />
<input type="hidden" id="ClaimTgtKbn" name="ClaimTgtKbn" value="{$ClaimTgtKbn}" />
<input type="hidden" id="Mrrg" name="Mrrg" value="{$Mrrg}" />
<input type="hidden" id="MrrgNm" name="MrrgNm" value="{$MrrgNm}" />
<input type="hidden" id="BuyExp" name="BuyExp" value="{$BuyExp}" />
<input type="hidden" id="BuyExpNm" name="BuyExpNm" value="{$BuyExpNm}" />
<!-- <input type="hidden" id="Comment" name="Comment" value="{$Comment}" /> -->
<input type="hidden" id="Other" name="Other" value="{$Other}" />
<input type="hidden" id="SiteKbn" name="SiteKbn" value="{$SiteKbn}" />
<input type="hidden" id="Address" name="Address" value="{$Address}" />
<!-- <input type="hidden" id="Address1" name="Address1" value="{$Address1}" /> -->
<!-- <input type="hidden" id="Address2" name="Address2" value="{$Address2}" /> -->
<input type="hidden" id="JobKbn" name="JobKbn" value="{$JobKbn}" />
<input type="hidden" id="JobNm" name="JobNm" value="{$JobNm}" />
<input type="hidden" id="Sex" name="Sex" value="{$Sex}" />
<input type="hidden" id="SexNm" name="SexNm" value="{$SexNm}" />
<input type="hidden" id="Charge" name="Charge" value="{$Charge}" />
<!-- <input type="hidden" id="ChargeNm" name="ChargeNm" value="{$ChargeNm}" /> -->
<!-- <input type="hidden" id="ChargeNmKana" name="ChargeNmKana" value="{$ChargeNmKana}" /> -->
<input type="hidden" id="TenpoNm" name="TenpoNm" value="{$TenpoNm}" />
<input type="hidden" id="TenpoMail" name="TenpoMail" value="{$TenpoMail}" />
<!-- <input type="hidden" id="PrefCd" name="PrefCd" value="{$PrefCd}" /> -->
<input type="hidden" id="PrefName" name="PrefName" value="{$PrefName}" />
<input type="hidden" id="AgeKbn" name="AgeKbn" value="{$AgeKbn}" />
<input type="hidden" id="AgeNm" name="AgeNm" value="{$AgeNm}" />
<!-- <input type="hidden" id="Busho" name="Busho" value="{$Busho}" /> -->
<input type="hidden" id="BukkenCd" name="BukkenCd" value="{$BukkenCd}" />
<input type="hidden" id="Matrix" name="Matrix" value="{$Matrix}" />
<!-- <input type="hidden" id="Yakushoku" name="Yakushoku" value="{$Yakushoku}" /> -->
<input type="hidden" id="Zip" name="Zip" value="{$Zip}" />
<!-- <input type="hidden" id="Zip1" name="Zip1" value="{$Zip1}" /> -->
<!-- <input type="hidden" id="Zip2" name="Zip2" value="{$Zip2}" /> -->
<input type="hidden" id="TargetKbn" name="TargetKbn" value="{$TargetKbn}" />
<input type="hidden" id="TargetNm" name="TargetNm" value="{$TargetNm}" />
<input type="hidden" id="ComId" name="ComId" value="{$ComId}" />
<input type="hidden" id="HikkoshiRiyuuText" name="HikkoshiRiyuuText" value="{$HikkoshiRiyuuText}" />
<input type="hidden" id="HikkoshiRiyuu" name="HikkoshiRiyuu" value="{$HikkoshiRiyuu}" />
<input type="hidden" id="HikkoshiRiyuuSonota" name="HikkoshiRiyuuSonota" value="{$HikkoshiRiyuuSonota}" />
<input type="hidden" id="NeedTokushuuText" name="NeedTokushuuText" value="{$NeedTokushuuText}" />
<input type="hidden" id="NeedTokushuu" name="NeedTokushuu" value="{$NeedTokushuu}" />
<input type="hidden" id="NeedTokushuuSonota" name="NeedTokushuuSonota" value="{$NeedTokushuuSonota}" />
<input type="hidden" id="KounyuuKeikenText" name="KounyuuKeikenText" value="{$KounyuuKeikenText}" />
<input type="hidden" id="KounyuuKeiken" name="KounyuuKeiken" value="{$KounyuuKeiken}" />
<input type="hidden" id="SonotaZassiText" name="SonotaZassiText" value="{$SonotaZassiText}" />
<input type="hidden" id="SonotaZassi" name="SonotaZassi" value="{$SonotaZassi}" />
<input type="hidden" id="SonotaZassiName" name="SonotaZassiName" value="{$SonotaZassiName}" />
<input type="hidden" id="SoufuKibouJyouhoushiText" name="SoufuKibouJyouhoushiText" value="{$SoufuKibouJyouhoushiText}" />
<input type="hidden" id="SoufuKibouJyouhoushi" name="SoufuKibouJyouhoushi" value="{$SoufuKibouJyouhoushi}" />
<input type="hidden" id="KikkakeText" name="KikkakeText" value="{$KikkakeText}" />
<input type="hidden" id="Kikkake" name="Kikkake" value="{$Kikkake}" />
<input type="hidden" id="KikkakeSonota" name="KikkakeSonota" value="{$KikkakeSonota}" />
<input type="hidden" id="JyuushiKoumokuText" name="JyuushiKoumokuText" value="{$JyuushiKoumokuText}" />
<input type="hidden" id="JyuushiKoumoku" name="JyuushiKoumoku" value="{$JyuushiKoumoku}" />
<input type="hidden" id="JyuushiKoumokuSonota" name="JyuushiKoumokuSonota" value="{$JyuushiKoumokuSonota}" />
<input type="hidden" id="FavFlg" name="FavFlg" value="{$FavFlg}" />
<input type="hidden" id="Did" name="Did" value="{$Did}" />
<input type="hidden" id="Sid" name="Sid" value="{$Sid}" />
<input type="hidden" id="UAKbn" name="UAKbn" value="{$UAKbn}" />
<input type="hidden" id="CampaignLocationFlg" name="CampaignLocationFlg" value="{$CampaignLocationFlg}" />
<input type="hidden" id="TimeStr" name="TimeStr" value="{$TimeStr}" />
<!-- 共通パラメータここまで -->
	</div>
